Abstract This project will improve the efficiency and quality of healthcare for persons with sickle cell disease, an under-served and at risk population by implementing a co-management model of care. Many patients with sickle cell disease (SCD) receive care primarily from specialty physicians and emergency departments (ED), thus resulting in a lack of primary care and a high number of ED visits and hospitalizations. Study team members will disseminate a toolbox of decision support tools, based upon the National Heart, Lung and Blood Institute (NHLBI) published ?Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014?, to primary care and emergency department providers in North Carolina and portions of South Carolina. The goal is to improve PCP and SCD specialist co-management. We will survey providers about their perception of the awareness, use and acceptability of the tools. We will survey patients about the awareness and acceptability of the co-management model. We will also conduct an exploratory cost analysis. The overall purpose of this demonstration and dissemination project is to evaluate patient and system outcomes associated with the dissemination of a toolbox of decision support tools to PCP?s and ED providers across NC and SC. The specific aims of the project are to: 1. Examine the effects of the decision support tools on study outcomes [ED visits, hospitalization, re-hospitalization within 30 days, PCP and/or SCD specialty visits, co- management, and HU prescription fills] during the 12 months prior to project start and across the 3.5 years of the project in NC and SC. 1.1. Determine which patient (age, gender, rural residence) and practice level (specific CCNC networks, specific PCP practices) characteristics, and receipt of the dissemination tools) predict study outcomes. 2. Evaluate individual provider-reported awareness, acceptability, and provider-reported use of each of the health maintenance tables and algorithms in the toolbox amongst PCPs, SCD specialists, and ED providers in NC and SC at project start and yearly across the project. 2.1. Explore patient-reported awareness and acceptability of a co-management model of care in NC and SC. 3. Conduct an exploratory cost analysis of the dissemination and implementation of the SCD co- management model and its effect on healthcare resource utilization.